Individual
MARY A LUALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH D
Contact information
Practice address
72 EAST 91ST ST, NEW YORK, NY 10128-1350
(212) 722-2303
(212) 876-9215
Mailing address
72 EAST 91ST ST, NEW YORK, NY 10128-1350
(212) 722-2303
(212) 876-9215
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
006357
NY
Other
Enumeration date
11/21/2006
Last updated
07/08/2007
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